May 16, 2018

expert reaction to study of wealth and dementia

A new study, published in JAMA Psychiatry, aims to examine the relationship of education, wealth, and area-based deprivation with the incidence of dementia over the last decade in England and investigate differences between people born in different periods.

Prof Tom Dening, Professor of Dementia Research at the University of Nottingham, said:

“This is an interesting and important study. As the authors themselves mention, socio-economic factors (wealth and deprivation) affect many other conditions such as depression, vascular disease and stroke. It would therefore be surprising if this wasn’t also the case for dementia. However, it has been quite difficult to investigate this for various reasons. For example, in population-based research, it is quite difficult to get a good measure for social deprivation or for wealth – for instance, if you try to use occupation as a measure, everybody above a certain age seems to be retired. You can use place of residence (e.g. postcode) but this isn’t very precise. Many studies have therefore concentrated on educational level as the amount of formal education that someone has received does affect their material prospects and likelihood of prosperity in later life. [At least, that has been true in the past, maybe less so in recent years.] This study suggests that the effect of education is relatively small, which should set off an interesting debate.

“Many of the studies that the press has reported about potential risk factors for dementia, such as stress in middle age, living close to busy roads, diet, lack of exercise, etc, feature things that are closely linked to socio-economic factors. You are likely to have a worse diet if you can’t afford to eat better, etc.

“Money is not the meaning of life (in my humble opinion) but it can help in terms of where you live and the social opportunities that are available to you in later life. It is likely that if wealth is associated with a lower risk of getting dementia, then it acts through these mechanisms, including contributing to better general health. It is however important to point out that the reduction in risk is still relatively small and being wealthy doesn’t prevent dementia. “Money can’t buy me love” – but maybe it can help the brain a bit.”

“This is an important observation from the valuable English Longitudinal Study of Ageing cohort. The authors have been able to link and increased risk of developing a dementia to social and economic deprivation. This adds to the same observation in other cohorts but provides more economic and social detail. The study relies on a clinical diagnosis of dementia and it was not possible to determine whether the risk related to Alzheimer’s disease or to vascular dementia. Vascular dementia shows a strong link to vascular risk factors such as smoking, high blood pressure and sedentary life styles. The authors were careful to account for vascular risk factors and the association with deprivation could not be explained by poor general health alone.”

* ‘Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England: Evidence From a 12-Year Follow-up in the English Longitudinal Study of Ageing’ by Dorina Cadar et al. published in JAMA Psychiatry on Wednesday 16 May 2018.